Provider First Line Business Practice Location Address:
101 S FICKETT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90033-4017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-262-8108
Provider Business Practice Location Address Fax Number:
323-261-3548
Provider Enumeration Date:
11/26/2007